产前诊断与产后序贯治疗对胎粪性腹膜炎患儿临床结局的影响

Effects of prenatal diagnosis and postnatal sequential therapy for meconium peritonitis

目的探讨产前诊断与产后序贯治疗对胎粪性腹膜炎的治疗意义。方法收集2014年4月至2018年4月在广州市妇女儿童医院新生儿外科住院,确诊为胎粪性腹膜炎(meconium peritonitits,MP)的患儿(n=46 )作为研究对象,按是否行产前诊断及产后序贯治疗,分为产前诊断组(n=27)和产后诊断组(n=19)。产前诊断组均接受产前诊断及产后序贯治疗,产后诊断组为产后才诊断此病并进行治疗。比较两组在早产儿比例、出生体重、性别、MP病理类型、术前C反应蛋白(C-reactive protein,CRP)水平、入院时年龄、住院时间、住院费用、肠造瘘率、肠功能恢复时间、病死率和术后并发症等方面的差异。结果两组在早产儿比例、性别、出生体重和MP病理类型方面差异无统计学意义(P>0.05)。产前诊断组入院年龄为(0.38±0.43)d,较产后诊断组[(6.89±10.74)d]更小,差异有统计学意义(t=-2.64,P=0.017)。产前诊断组术前CRP水平为(6.6±22.0)mg/L,较产后诊断组[(36.6±29.6)mg/L]低,差异有统计学意义(t=-2.43,P=0.019)。产前诊断组术后肠功能恢复时间为(13.85± 8.84)d,较产后诊断组[(21.11±14.87)d]短,差异有统计学意义(t=-2.031,P=0.049)。两组手术患儿进一步比较,产前诊断组手术者造瘘率(61.54%)较产后诊断组手术者(100%)低(P= 0.01);术后肠功能恢复时间[(20.38±5.53)d]较产后诊断组手术者[(30.93±15.47)d]短,差异有统计学意义(t=-2.390,P =0.04);住院时间[(23.69±6.15)d]较产后诊断组手术者[(33.71±16.21)d]短,差异有统计学意义(t=-2.152,P=0.046)。结论产前诊断及产后序贯治疗有利于加快MP手术患儿的肠功能恢复,缩短住院时间,降低肠造瘘率,对于MP患儿的诊疗有积极的临床意义。

Objective To evaluate the effects of prenatal diagnosis and postnatal sequential therapy for meconium peritonitis (MP). Methods Retrospective review was conducted for the clinical data of 46 inpatients with a final diagnosis of MP from April 2015 to April 2018.According to whether or not adopting prenatal diagnosis and postnatal sequential therapy,they were divided into prenatal diagnosis group ( n =27)(adopt prenatal and postnatal sequential therapy) and postnatal diagnosis group ( n =19)(not adopt sequential therapy as control).The parameters of preterm neonate rate,birth weight,gender ratio,preoperative value of C-reactive protein (CRP),age at admission,length of hospital stay,total hospitalization cost,MP pathological type,operative ratio,enterostomy ratio,intestinal function recovery time,mortality and complications were reviewed. Results No significant inter-group differences existed in preterm neonate rate,gender ratio,MP pathological type and birth weight.The age at admission was significantly younger in prenatal diagnosis group than that of control group [(0.38±0.43) vs.(6.89±10.74) days, t =-2.64, P =0.017];The preoperative CRP value was significantly lower in prenatal diagnosis group than that in control group [(6.6±22.0) vs .(36.6±29.6) mg/L, t =-2.43, P =0.019];The intestinal function recovery time was significantly shorter in prenatal diagnosis group than that of control group [(13.85±8.84) vs .(21.11±14.87) days, P =0.049].For operated neonates in two groups,enterostomy ratio was significantly lower in operated children of prenatal diagnosis group than those of control group (61.54% vs .100%, P =0.01).In prenatal diagnosis group,intestinal function recovery time after surgery was faster than control group [(20.38±5.53) vs.(30.93±15.47) days, P = 0.04 );The length of hospital stay was shorter than control group [(23.69±6.15) vs .(33.71±16.21) days, P =0.046]. Conclusion Prenatal and postnatal sequential therapy can shorten intestinal function recovery time,reduce the length of hospital stay and lower the enterostomy ratio for operated MP children.